Rheumatic Disorders in Primary Care: A Study of Two Primary Care Centres and a Review of Previous Swedish Reports on Primary Care

Abstract

Utilization of care for rheumatic disorders was studied in two primary care units. In both units 12% of visits concerned some form of rheumatic disease. This diagnostic group (chapter XIII of ICD) ranked third after cardiovascular and respiratory diseases. The total number of visits per inhabitant was higher for all diagnoses, as well as for the rheumatic disorders, in the most remote primary care unit. The distribution of rheumatic diagnoses was similar in the two units. Back disorders were most frequent among men, whereas soft tissue rheumatism and back disorders each accounted for one-third of the cases among women. Inflammatory rheumatic diseases and osteo-arthritis played only a minor part. Visits due to rheumatic disorders decreased after retirement age, particularly among men. The findings were representative of primary care in rural areas of Sweden. Only 20% of referrals from primary care to the rheumatology department gave a tentative diagnosis and half of these suggestions were changed after examination. The majority of referred patients without any suggested diagnosis suffered from soft tissue rheumatism or inflammatory rheumatic disorders other than rheumatoid arthritis.

Lag time between onset of symptoms and diagnosis in Venezuelan patients with rheumatoid arthritis

“…More than 75% of patients show erosions within the Wrst 2 years of disease and structural damage contributes to approximately 25% of cumulative disability [3]. The beneWt of early therapy in the prevention of damage and disability has been clearly proven in several independent studies [1][2][3][4][5][6][7]. Mean lag time before diagnosis in our study was 40.5 months .…”

“…In general, previous studies have shown poor agreement in the diagnosis of RA between primary care physicians and rheumatologists [1,15,[24][25][26][27][28][29]. Gamez-Nava et al…”

“…A key to prevent signiWcant joint damage is early diagnosis and institution of appropriate and timely therapy to prevent permanent disability [1][2][3][4][5][6]. A window of opportunity for prevention of damage in RA has been proposed [7] since joint erosions, a harbinger of future joint damage and disability [8], can appear as early as 3 months after onset of symptoms [9].…”

Diagnostic Accuracy for Lupus and Other Systemic Autoimmune Diseases in the Community Setting

“…Final diagnoses were arrived at by consensus among a group of specialists using accepted diagnostic criteria. 17,18 As all patients underwent complete reevaluation, bias introduced by knowing the referring physicians' diagnoses was minimized. The low rate of agreement between the referring and final diagnosis supports that conclusion.…”

Development of a Multidimensional Additive Points System for Determining Access to Rheumatology Services

“…6 The majority of referrals to rheumatology originate in primary care; musculoskeletal disorders are estimated to account for up to 12% of visits to primary care physicians. 7 Many primary care physicians express low levels of confidence in their ability to recognize and manage musculoskeletal conditions, 8 which may account, in part, for the poor quality of referrals; data from the United Kingdom identified the absence of basic information in more than 50% of referrals. 9 A subsequent Canadian study has shown that the absence of historical and laboratory information can lead to the inappropriate triage of urgent referrals.…”